Thursday, November 18, 2010

THE HEALTHCARE DEBATE: And the Spectacle of Polarization

We have a problem we are trying to resolve, a large number of perspectives, and no simple solution.  This 2,500 word outline of current developments in the healthcare debate will be too long for some and too short for others.  To ease into the unpleasantness, I’ve divided this discussion up into categories.

I.                    Partisan Distortions
I doubt that President Barak Obama spends a great deal of time surfing through right-wing websites.  Why would he?  Obama’s been called an idiot by many that cannot spell and has, like every President since World War II, been compared to Adolf Hitler.   In the context of our current President this is amusing since we would have to search in vain to find one Harvard educated black man espousing the policies of National Socialism.  What makes Obama’s situation noteworthy is that the irrationality on the far right is so well organized.  This is mostly due to talk radio and right wing bloggers.

However, the right does not have a monopoly on lunacy.  The far left proponents of universal healthcare have a penchant for meaningless or misleading statistics.  For example, a study by Harvard Medical School and Cambridge Health Alliance mention that 45,000 Americans die annually because they don’t have health insurance - which is a tremendous exaggeration.  These numbers are almost 250% higher than those taken from previous studies.  (A more reliable study by the Congressional Budget Office estimated that – all else being equal - those “involuntarily uninsured” had about a three percent more chance of dying than those insured aged 61 or younger.)  Probably, the Harvard/Cambridge study statistics were conjured up because those authoring this study have an agenda concerning getting various healthcare measures implemented.  Among other studies, we also have the World Health Association (WHO) ranking the United States health care system as 37th in the world.  As part of this ranking, WHO looked at reported statistics for infant mortality, longevity, etc.  The key term is reported as the method of reporting between nations is not uniform.  Almost all nations have a different definition as to what infant mortality is, and there is no way to verify whether reported statistics for other countries are accurate - besides taking at face value what is and is not reported by governments that have a motivation to make such statistics appear in the most positive light. 

Emotionalism has charged the debate and caused all reasonableness to vanish.  Just as George W. Bush was the personification of evil to those on the left from the years 2000 to 2008, so Barak Obama and, especially, Nancy Pelosi have become personifications of evil for those on the right.  There is no reaching across the aisle.  Those on the right and left are always in a constant strife for power, and misinformation is a powerful weapon to be used.  That both sides express outrage when such attempts to deceive are discovered is part of the game.  It is inconceivable to opponents or proponents of universal healthcare that there are well-meaning individuals on both sides of the debate that are knowledgeable of the issues.  The contention concerning the various healthcare issues has caused those who have actually thought these questions out to shy away from the debate – so we are left hearing only from those with agendas.

II.                 Media Distortions

Sadly, politicians have been more honest about healthcare than the media.  At least Congress had to vote on House Bill 3200 that passed by the narrow margin of 220–215.  That the bill was passed by such a small majority is indicative that Congress is taking the measure seriously.  With town hall meetings being held across America and with voters taking to the streets, representatives displayed courage by passage of the proposal.  Of course, that doesn’t mean they’re right.  I remain underwhelmed in the knowledge that most members of Congress did not read the 1994 page bill in its entirety.  (I’m more disturbed that this is how Congress passes every piece of legislation.)  I’m still willing to wager that more members of Congress read the entire bill than members of the media.  I say this because, though some in the media are aware of provisions concerning immigration or non-coverage of the costs of abortion, I hardly ever read a column that takes the entire bill into context.

I tend to dismiss almost any column written by Paul Krugman, George Will, Ellen Goodman or John Stossel because their bias is pronounced.  I also tend to stop reading when the headline of a newspaper column matches the editorial policy of that particular publication.  Most importantly, I feel insulted when a columnist takes a politician at his or her word.  A recent example of this was when Ruth Marcus, of the Washington Post, accused the GOP of providing misinformation when GOP leaders suggested that the costs of the healthcare bill could not be met by only raising taxes on the top .03 richest of all households.  And though while not trusting Republicans, Ms. Marcus believes the promises of Democrats that no one else’s taxes will be raised.   This is disingenuous because budgets for major piece of legislation have to be questioned.  Social Security, Medicare, Medicaid and the funding for the wars in Iraq or Afghanistan have all greatly exceeded budgetary expectations and healthcare will be no exception.

For conservative columnists, there’s Karl Rove’s take on the whole debate.  Rove has written for the Wall Street Journal criticizing the Obama administration for not being more fiscally responsible.  Considering the role that Rove played in the Bush administration where deficits nearly doubled, one has to take Rove’s critique at arm’s length. 

Thankfully, I’m occasionally surprised by isolated reporting within the media.  A recent article by David Corn of Mother Jones magazine, known for its progressive leanings, took President Obama to task about not being serious on the issues and suggested that Obama had a “credibility gap.”  Dan Gerstein of Forbes magazine, which definitely has conservative leanings, has criticized Republicans for refusing to engage in an honest debate about costs of the healthcare plan.  Instead, he asserts, they are making up figures to thwart the healthcare package in its entirety.

III.               Policy  Concerns

Rather than merely parrot what other columnists have said before, let me at least try to attempt to state my own concerns.  First and foremost of considerations is that nobody can truly say how much this healthcare package will cost, though it most certainly will exceed what proponents suggest.  We are just coming out of a recession, unemployment is around ten percent, deficits are at $1.4 trillion annually and rising and the debt now exceeds $12 trillion.   It is thus inconceivable to suggest that a complete overhaul of our nation’s health system can be done while only raising the taxes of (again) .03 of the richest households in the country.  The government was already desperately short on funds before a healthcare proposal even made its way towards Congress. 

There are also intangibles regarding costs that will be determined by changes in political mood.  It is suggested that cost savings can be made by cuts to Medicare, but how will those cost savings be perceived if coalitions of senior citizens can determine outcomes of elections?  The answer is that Congress will be forced to cater to the seniors by approving additional funds to Medicare while still spending money on healthcare.  There will be no cost savings whatsoever.  Also, we don’t know what direction the two wars that are currently being funded will take or even if increased troop movements will be necessary.  If deficits due to increased defense spending continue, what will be the taxpayer and small business person’s attitude towards their elected officials when the dollar is devalued and inflation and/or taxes increase?  Citizens may be willing to pay additional taxes to make sure there is healthcare coverage for all Americans, but this will only occur if voters believe that Congress has some level of control concerning spending. 

It would certainly seem noble if political leaders could put aside politics and vote for what they feel is right.  Politicians like Nancy Pelosi and Barney Frank have some leeway in this regard because they reside in districts where a vote for healthcare will not cost them a position.  Not all politicians have that luxury.  Some will be voted out for supporting reform and Republicans could win many more seats in the House and Senate.  Not all Democrats will want to take that gamble.

Another item to ponder is what kind of policy considerations will have to be implemented to appease lobbyists to pass healthcare reform.  The insurance industry and conservative politicians have for years pushed for some kind of tort reform to protect businesses from messy and potentially costly lawsuits.  Proponents of universal healthcare reforms appear to be on the brink of caving into these demands by spinning tort reform (partially through caps on personal injury and medical malpractice jury verdicts) as a cost saving measure that could be used to make healthcare reform more affordable.  What could occur is that Republicans lambasting Democrats in Congress for trying to ram through healthcare initiatives too quickly will be given the opportunity to ram through tort reform without any debate whatsoever.  Tort reform is as complex of an issue as universal healthcare coverage and requires debate.  This is especially true with the number of constitutional considerations that must be looked at before we begin taking away the power from juries.  It’s foreseeable that a case involving tort reform could end up on the docket for the United States Supreme Court as a result of this.

Lobbying by labor will certainly have to be taken seriously by both houses.  Labor unions, that have traditionally heavily favored Democratic candidates, find themselves uncomfortable with government sponsored healthcare plans that will remove healthcare insurance from the area of employment.  Benefits such as health insurance have often been used by unions as a bargaining tool to motivate employers to comply with union demands.  The unions are also non-supportive of any excise tax on the higher rate health insurance plans (the "Cadillac" plans) which may yet show up in the Senate version of the bill.

Also, Immigration and abortion lobbying efforts have already slowed down votes on healthcare legislation by several months.  If the debate continues well into next year – right before the federal elections of 2010 are to take place – the chances that we will have legislation that could ever be defined as sweeping will greatly decrease.  It could be that healthcare reform will be passed in name only just so the Congress, Senate and the Executive Branch can boast that they got the job done.

IV.               Cultural Considerations

Last, we have to decide whether we can live with legislation that is less than perfect.  Proponents of universal healthcare reform are probably correct in believing that mere tweaking of the system will not result in any kind of reform at all.  If no reform is passed, we will continue to have around fifteen percent of the population uninsured (and we may still have that even if the reform is passed).  And if the watered down reform “supported” by Republicans is put in place, many procedures will continue not to be covered in the “cheaper” insurance plans.  Yet politically, is it even possible that meaningful reform can be passed without it first being altered?  The insurance and pharmaceutical industries have too much power to allow the proponents to absolutely have their way.  We also need to remember that the bill that barely passed in the House will not be the same one that the Senate will vote upon (the Senate package – which I haven’t had a chance to read - is 2074 pages, but budgeted for “only” $849 billion as compared to the House’s at $1.2 trillion).  Even if House Bill 3200 happened to be perfect, the provisions will be greatly changed in the Senate version.  We don’t even know if the U.S. Senate will endorse a “public option.” 

Now proponents of universal healthcare have made the argument that some sort of healthcare package needs to be passed to get the ball rolling or conservatives will obstruct passage of legislation for many more years.  They say that even if passed, the legislation can be necessarily altered if problems should arise.  On the other hand, opponents of these measures would say that once the Genie is out you will never again get it back in the bottle.  They say that with universal healthcare reform, prices will spiral, medical advancements will be slowed, and the United States may never again be at the forefront of medical technology.  The proponents and opponents may both be right.

There are many that advocate that the United States should follow the single-payer examples of European nations.  But since even “public option” advocates like Senator Jay Rockefeller have achieved no success, let’s have one politician propose a single-payer system and one will understand why the debates on healthcare have been going on for more than sixty years.  European nations – and in particular Scandinavian countries – are willing to adopt “one size fits all” solutions.  In America, “one size fits all” is anathema.  Americans pride themselves on their individuality and differences.  We are the “melting pot” with a greater variety of ethnicities, cultures and (with the possible exception of India) religions than any other nation in the world.  For better or worse, any proposal that passes is going to have to correspond to our uniquely American way of thinking.

V.                 Final Thoughts

If I had my way, every self-proclaimed liberal should have to read the Wall Street Journal on a daily basis, and every individual claiming they are proud to be of conservative persuasion should be forced to read the New York Times from cover to cover.  Maybe then they would at least understand if not appreciate some of the arguments from the other side.  In any case, such a requirement might hopefully shut them up.  To believe that labeling oneself liberal or conservative is sufficient enough justification to support or oppose this or any issue for that matter is simple laziness.  Smugness among political partisans is supreme.  Yet universal healthcare reform requires so many different considerations as to who will and will not be hurt as a result of passing or not passing the legislation that smugness needs to be shelved.  Do we cater first to the needs of the poor, middle-class, taxpayers, laborers, doctors and hospitals, chiropractors and maybe even acupuncturists, immigrants, women, men, spouses, domestic partners, senior citizens, infants, self-employed or the unemployed?  All of this must be sifted through and needs must be prioritized. All of these groups of individuals will come to the table with their spokesmen and with their hand out.  Whether we pass this legislation should only be decided after we figure out whether the value we will receive is equal to or exceeds the price we have to pay.  This reasoned debate has not yet taken place.

November 19, 2009 
© Robert S. Miller 2009

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